Recombinant human erythropoietin(Center of Molecular Immunology)

Background Myelodysplastic syndromes (MDS) are clonal myeloid disorders characterised by ineffective haematopoiesis, leading to anaemia that often requires dependence on red blood cell (RBC) transfusions. Epoetin alfa (Eprex®) is now a mainstay in the management of symptomatic anaemia in low-risk MDS patients, reducing transfusion dependence and improving the quality of life in this patient group. Objective This retrospective study aimed to assess the efficacy of epoetin alfa in treating symptomatic anaemia in low-risk MDS patients, focusing on transfusion independence and its relationship with baseline erythropoietin (EPO) levels and haemoglobin (Hb) response. Methods Data from 56 patients with low-risk MDS treated with epoetin alfa at Norfolk and Norwich University Hospital, Norwich, United Kingdom, between 2018 and 2023 were retrospectively analysed. Baseline EPO levels, transfusion history, Hb response, and the duration of transfusion independence were assessed. Statistical analyses were performed to evaluate the correlation between baseline characteristics and treatment outcomes. Results Among the patients, 98.2% had baseline EPO levels below the 500 IU/L threshold, with a median EPO level of 74.3 IU/L. Following an eight-week trial of 30,000 units of epoetin-alfa, 41.1% of patients showed improved Hb levels, 41.1% maintained stable Hb levels, and 17.9% experienced a decline. A significant correlation was found between lower baseline EPO levels (<250 IU/L) and a positive treatment response (p = 0.0065). Additionally, patients who required fewer transfusions before treatment had longer durations of transfusion independence (correlation coefficient = -0.40, p = 0.015). Dose escalation to 60,000 units provided a benefit to 53.3% of patients with initially stable Hb levels. The average duration of transfusion independence was 8.1 months, and patients with improved Hb levels had the longest periods of transfusion independence (p = 0.005). Conclusion Epoetin alfa is an effective therapy for managing symptomatic anaemia in low-risk MDS patients. This study highlights its efficacy and provides valuable predictive information, particularly showing that patients with lower baseline EPO levels are more likely to respond to treatment. While prior transfusion dependence did not significantly predict response to therapy in this cohort, it was associated with the duration of transfusion independence.

Oncoplastic reconstruction (IOR) performed in conjunction with breast conserving therapy (BCT) has been found to improve psychosocial well‐being, reduce hospitalization time, and reduce cost burden. Few studies have looked at the safety profile, complication rates, and overall outcomes in patients ages 65 years and older undergoing IOR versus BCT alone.

A retrospective, cross‐sectional, single‐institution medical record review was conducted of women diagnosed with breast cancer age 65 years or older who received IOR or BCT alone. Demographics, clinical data, and major and minor complication profiles were compared between cohorts.

A total of 310 patients were included. Of these, 126 received IOR, while 184 received BCT alone. Age >85 was found to have a significantly higher risk for any complication and was an independent predictor for experiencing any complication (OR: 8.5, p = 0.015; OR: 1.06, p = 0.029). Major complication rates were significantly higher in the BCT cohort (16.9% vs. 7.9%, p = 0.023).

IOR in the elderly is a safe option and was not found to be a predictor of experiencing higher complications. Patients who are 85 years and older had a higher risk of complications, and future studies may explore risk‐benefit in that particular cohort of patients in which BCT is planned.